Sylvia do Carmo Castro Franceschini

Habilidade de indicadores antropométricos e de composição corporal em identificar a resistência à insulina

OBJECTIVE To assess the ability of anthropometric and body composition indicators in identifying insulin resistance (IR), determining cut-off points for those showing the best efficacy. METHOD 138 men were evaluated. Waist perimeter (WP), sagittal abdominal diameter (SAD), conicity index, body mass index (BMI), body fat percent, sagittal index, and the waist-to-height, waist-to-hip and waist-to-thigh ratios were determined. IR was assessed by the HOMA-IR index. Statistical analysis consisted of Spearman correlation coefficient and ROC (receiver operating characteristic) curves, calculating the area under the curve (AUC). RESULTS SAD (r=0.482, AUC=0.746) and WP (r=0.464, AUC=0.739) showed stronger correlations with the HOMA-IR and greater ability to identify IR (p<0.001), being 89.3 cm and 20.0 cm the best cut-offs, respectively. CONCLUSION The anthropometric indicators of central obesity, WP and SAD, have shown greater ability to identify IR in men. We encourage studies in women and elderly people in search of the best cut-off points for the entire population.

Differences in the hemoglobin cut-off point for the diagnosis of anemia as a function of race/color

Hemoglobin levels vary according to age, gender, different phases of pregnancy, smoking habit, and altitude. In the early 90s, researchers began to notice unexplained differences in hemoglobin levels between whites and blacks in various age groups. Since then, studies began to be published to identify which factors would be responsible for such differences. From a review of the literature, we aimed at exposing relevant aspects that may assist in the understanding of why blacks have lower levels of hemoglobin in relation to whites. The Medline, Lilacs, and Pubmed databases were used for this review. Studies have shown that the levels of hemoglobin in blacks are lower, ranging between 0.5 and 1 g/dL in relation to whites. This difference remains, even controlling for possible confounding factors such as intake and iron nutritional status, socioeconomic status, age, and comorbidities among others. The studies, however, do not come to a conclusion about what raises this difference between races. Therefore, proposing specific cut-off points as a function of race, as some authors suggest, may be precipitated and result in not identifying people with anemia, which is considered a serious public health problem in Brazil.

Diagnosis of Obesity Using Anthropometric Indices in Urban Populations: Brazilian Perspectives

There is a consensus in the literature that the etiology of obesity is multifactorial, caused by interaction of several factors. The parameter used for diagnosis is established by the WHO and defined by the body mass index (BMI), obtained by calculating the ratio between body weight (kg) and square of the height (m2). An adult is considered obese when for BMI greater than or equal to 30 kg/m2. In Brazil, an increase in obesity has been observed in all regions, especially in the South and Southeast regions, and more in urban than rural areas. This evolution is concomitant to a nutritional transition process, showing great change in the Brazilian diet pattern. Decrease in malnutrition and increase in obesity in adults were identified when two national surveys were compared: The National Study on Family Expenses [Estudo Nacional sobre Despesas Familiares] (1974/1975) and the National Health and Nutrition Survey [Pesquisa Nacional de Saude e Nutricao] (1989). The evolution of obesity in Brazil took place in a relatively short time, and controlling it became a priority in the country public health policies. Among the several factors that determine obesity, are urbanization, which has changed diet patterns; sedentary lifestyle, which has contributed to weight excess; and a change in nutritional indicators. Hence changes in diet patterns indicate urgency in directing health and nutrition policies towards minimizing the problem of obesity in adults in Brazil.

Anthropometry of Adolescents: Brazilian Perspectives

Health status of Brazilian adolescents is directly affected by huge inequalities, considering the social and economic conditions they are submitted to. According to a national survey, 10% of adolescents present height-for-age deficit. The analysis of the secular trend of the nutritional profile of the group under discussion emphasizes the drop in height deficit for 30 years, although the prevalence observed is still considerable. On the other hand, there is increased prevalence of excess weight and obesity. Adolescents are in full transformation and the chronological age not always means similarity among peers. Hence, in some studies of female adolescents, the methodology includes a 1-year period after menarche to have a homogeneous sample and assure that the typical changes of adolescence influence less in the results. This methodology also enables adolescents assessed by non-medical professionals to have more specific orientations according to their sexual maturation stage. Despite the fact this methodology assesses sexual maturation close to real situation, it is known that there are limitations, mainly in males and in females who had no menarche yet.

Anthropometric Indexes of Low-Income Brazilian Children

Brazil is a very large country, with more than eight million square kilometers, and comprises five different regions with distinctive social and economic characteristics. This gives rise to considerable inter-regional disparities in the analysis of child health status. In the last four decades, five surveys were conducted nationwide, and the first survey showed that protein–energy malnutrition was the most serious nutritional problem among Brazilian children. However, these rates have been declining sharply in all Brazilian regions as a result of an improvement in the social and economic conditions of families and in the sanitation coverage, and of wider offer of and access to health services, education, and food supplementation programs. More recent studies indicate that although there has been a reduction in height deficit in all Brazilian regions, it is still significant among Brazilian children and affects 7.0% of them. In addition to socioeconomic, biological, and quality-of-life determinants, the prevalence of low height can be partially attributed to the high frequencies of iron deficiency anemia and vitamin A deficiency among Brazilian children (20.9% and 17.4%, respectively), considering the importance of these micronutrients on linear growth and immune response. Child obesity affects 6.6% of Brazilian children and should be addressed immediately by the National Food and Nutrition Policy.